Intervention Model Research Articles

Consultation-Liaison Psychiatry in Italy: historical development and models of intervention

AbstractThe birth of Consultation-Liaison (CLP) in Italy was made possible thanks to Act 180/1978, which started a 20-year-process that led to closing asylums and fostered the implementation of small psychiatric units within the general hospitals. In the meantime, Italian CLP grew steadily, fostered also by the enactment of two “Objective Mental Health Care” Plans (1994-1996 and 1998-2000), that led to the implementation of the organizational model of the mental health department (MHD).As far as psychiatric referrals are concerned, the first Plan states that the MHD covers all territorial and hospital-based activities, in order to assure, among other services, the integration with hospital (with special attention paid to the Emergency Department and to consultation activity in non-psychiatric hospital wards) and general medicine (as well as other sectors, including mother and child health care). With respect to psychiatric referral, the Second Plan states that “In the 24 months following the entry into force of the Plan, MHDs will adopt guidelines and procedure concerning several issues, including consultation-liaison activity in non-psychiatric hospital wards (which also includes mental health care for “psychiatric” patients hospitalized for non-psychiatric disease in the general hospital) and in Department of Addictions (for alcohol and other substances use disorders. According to the second Plan, Community Mental Health Services (CMHCs) provide, among other performances, CLP activity for general practitioners. Inside general hospitals, psychiatric referrals to non-psychiatric wards are provided by inpatient psychiatric units, when CLP Services are not available. Since a standard definition of psychiatric consultation is not available, the one provided by the Italian region Emilia-Romagna will be used. The Region includes “consultation” among mental health services provided by CMHCs, and defines it as follows: “Psychiatric or psychological assessment carried out upon request from other [non psychiatric] Departments. The consultation includes both clinical interview with the patient and the medical report for the department that referred the patient.” The ways to identify consultation as one among other types of services provided by the MHD are defined, to count the overall number of consultations and monitor the clinical activity of health professional working in the different branches of the MHD. The following types of consultations are reckoned: consultations requested by general practitioners (who work within the Primary Care Department); consultations requested by the Department of Addiction (a branch of the MHD); and consultations requested by the Department of Child-Adolescent Psychiatry (which, as the previous one, is a branch on the MHD).Disclosure of InterestNone Declared

Implementation supports to promote fidelity within a flexible, presentation-responsive MHPSS intervention model: A case study of Baby Friendly Spaces in Cox’s Bazar, Bangladesh

IntroductionAs evidence has converged on the feasibility and effectiveness of focused, non-specialized, manualized interventions for treating mental distress in humanitarian settings, challenges persist in how to promote implementation fidelity and rigorously evaluate interventions designed to be more preventive or promotive in addressing risk and protective factors for poor mental health. One such intervention, Baby Friendly Spaces (BFS), is a psychosocial support program implemented for Rohingya mothers and their malnourished children living in refugee camps of Cox’s Bazar, Bangladesh. That follows a place-based intervention model in which various activities may be offered either individually or in groups with no specified sequence.Objectives This presentation describes the process of establishing standards for implementing optimal mental health and psychosocial support (MHPSS) interventions, training BFS workers, and building monitoring and supervision systems to promote implementation fidelity within this flexible support program.MethodsAs BFS services were already being offered as part of Action Against Hunger programming, we first conducted an audit of current services, determining that there was limited current standardization or support for implementation. Therefore, a manualized protocol was designed and covered the program curricula and self-care using didactic and practice-based learning. A series of online training sessions were conducted for 13 psychosocial workers and psychologists at centers delivering the enhanced intervention. Following the training, a baseline evaluation of attitudes, confidence, and knowledge for delivering BFS services was administered. We also collaboratively designed a systematic supervision process to meet the staff’s needs with a focus on capacity building and self-care.ResultsFollowing the initial training, BFS workers receiving the re-training showed similar levels of knowledge, but greater confidence (p=0.01) than MHPSS workers proceeding as usual. Participants reported that the training was useful for their field of work and for improving the quality of their work, and acknowledged they would be able to integrate the new learnings into their work and daily life. The follow-up with the supervision process confirmed their capacity to deliver the services and highlighted the need for workspace improvements, the lack of continuous motivation, their ability to identify specific issues for which they requested additional trainings.ConclusionsThere is a particular need for careful attention to implementation supports and supervision when offering flexible, place-based mental health and psychosocial support interventions. In that process, ensuring a continuity between the training and the supervision is essential for the quality of both the program and the research project.Disclosure of InterestNone Declared

The Interplay Between Individual Mobility, Health Risk, and Economic Choice: A Holistic Model for COVID-19 Policy Intervention

This paper was motivated by the need to simultaneously address two competing policy objectives during the course of the COVID pandemic: namely, the public health objective, which required people to be less mobile, and the economic objective, which aimed to ensure that the economy was not adversely affected by the constraints imposed by the first objective. To realize these objectives, we developed a data-informed approach to model human mobility, health risk, and economic activity jointly. This approach computes equilibrium between epidemic models of public health and economic activity under policy interventions that could be used to change people’s mobility behavior. Our approach is distinctive in its capacity to assemble proprietary data sets from public and private sectors at the individual and the zip code levels, which heretofore had not been used together. These data enabled customization of the population-level epidemic models widely used in public health (e.g., the SIR model) with individual-level data traces of mobility behaviors for assessment of public health risks. The outputs of the proposed model enabled parameterization of economic choice models of individuals’ economic decision-making. Various policy interventions and their capacities to shift the equilibrium between economic activity and public health were investigated in this study. Whereas the data-informed joint modeling approach was developed and tested in the pandemic context, it is generalizable for the evaluation of any counterfactual policy interventions. History: Olivia R. Liu Sheng and W. Nick Street served as senior editors for this article. Data Ethics & Reproducibility Note: The code capsule is available on Code Ocean at https://doi.org/10.24433/CO.4390192.v1 and in the e-Companion to this article (available at https://doi.org/10.1287/ijds.2023.0013 ).

Involving community pharmacists in interprofessional collaboration in primary care: a systematic review

BackgroundThe World Health Organization supports interprofessional collaboration in primary care. On over the past 20 years, community pharmacists had been taking a growing number of new responsibilities and they are recognized as a core member of collaborative care teams as patient-centered care providers. This systematic review aimed to describe interprofessional collaboration in primary care involving a pharmacist, and its effect on patient related outcomes.MethodsA systematic review of randomized controlled trials cited in the MEDLINE, EMBASE, PsycInfo and CINAHL in English and French was conducted from inception to November 2022. Studies were included if they described an intervention piloted by a primary care provider and included a pharmacist and if they evaluated the effects of intervention on a disease or on patient related outcomes. The search generated 3494 articles. After duplicates were removed and titles and abstracts screened for inclusion, 344 articles remained.ResultsOverall, 19 studies were included in the review and assessed for quality. We found 14 studies describing an exclusive collaboration between physician and pharmacist with for all studies a three-step model of pharmacist intervention: a medication review, an interview with the patient, and recommendations made to physician. Major topics in the articles eligible for inclusion included cardiovascular diseases with blood pressure, diabetes, dyslipidemia, and risk of cardiovascular diseases. Positive effects concerned principally blood pressure.ConclusionsCollaboration involving pharmacists is mainly described in relation to cardiovascular diseases, for which patient-centered indicators are most often positive. It underscores the need for further controlled studies on pharmacist-involved interprofessional collaboration across various medical conditions to improve consensus on core outcomes measures.

Group therapy for problematic chemsex in Ngos community treatment settings in Spain

IntroductionThe intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Group therapy has been included in several programs for chemsex users.ObjectivesTo describe and to compare the different group therapy treatments for problematic chemsex users in NGOs community treatment settings in Spain.MethodsWe conducted several interviews with key informants from 5 NGO in Spain. A qualitative analysis of the different group therapy treatments for problematic chemsex was performed.Results Different models of groups were described including: psychoeducational, support, interpersonal process, harm reduction and mindfulness-based cognitive groups. Most of the group interventions developed were support and psychoeducational based. There were fewer interpersonal group and relapse prevention group therapy. The different models of group intervention were considered useful and necessary for deliver information in a culturally sensitive context and for reducing drug use, social isolation and loneliness.Conclusions Chemsex is a phenomenon that needs a multidisciplinary approach, including individual and group therapy. Group therapy for problematic chemsex has several advantages over individual model treatments, including the reduction of sense of isolation, loneliness, information and feedback from peers. More research is needed to analyze the implementation and efficacy of group therapy for chemsex users in different contexts.Disclosure of InterestNone Declared

Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.

Changing our way of working for a greater integration of mental health patients: The evolution of the Zamora’s Assertive Community Treatment over the last 10 years

IntroductionSince its beginning in the 1970s in Wisconsin, Assertive Community Treatment (ACT), has been adopted by numerous hospitals worldwide. It improves outcomes for people who are most at-risk of psychiatric hospitalization. The main goal is to provide a global attention with a focus on promoting maximum autonomy and facilitating integration into society. In 2012, the Health Care Complex of Zamora, Spain, adopted this pioneering approach to Mental Health. The main efforts were focused on creating a community network for individuals with severe mental disorders. It embraced a biopsychosocial model of intervention aimed at facilitating patient recovery, giving them tools to create a new life project based on their own autonomy.ObjectivesThe primary objective of this study was to assess the progress of the Assertive Community Treatment (ACT) since its introduction at the Health Care Complex of Zamora, with a specific focus on analyzing the number of hospitalizations as the dependent variable.Methods A quantitative analysis about psychiatry number of hospitalizations was conducted using the database of the Zamora’s Psychiatry Hospitalization Unit. SPSS Statistics for Windows was used to calculate statistical values related to number of hospitalization. The dataset covers de period from 2010 to 2017.ResultsThe implementation of ACT has resulted in a significant reduction in hospitalizations reaching up to 75% in the Psychiatry Service of Zamora. It has been revealed a decrease from 17107 hospitalizations registered in 2011 to a total reduction to 4869 stances in 2013. A consistent trend in the reduction of hospitalizations has been observed (figure 1).A restructuration of the Hospitalization Unit was performed in order to implement de community model and reduce hospitalizations. Removal of more than 50% of the beds was developed.Besides, there has been implemented a community subunit with the objective of regaining their autonomy after a psychiatric exacerbation.Image:ConclusionsGetting hospitalized in a Psychiatry Unit can have many different socio-laboral consequences. The ACT model has demonstrated a significative reduction in hospitalizations and it has evolved into a support network dedicated the integration of individuals that are usually left behind by society. Moreover, it presents itself as a positive cost-benefit intervention.ACT allows us to envision a future with fewer hospitalization and greater integration of mental health patients into modern society.It is important to emphasize that the city of Zamora possesses unique characteristics that have facilitated the adaptation of this model. Not only are the rental prices for housing usually affordable, but the city’s small size, which easy walking, allows for easy access to Community Mental Health resources and services.Disclosure of InterestNone Declared

Eating disorders: the increase in requests for help and the optimization of resources

IntroductionThis work aims to provide an updated overview of the eating disorders (EDs) which are a widespread pathology nowadays. Informations related to the clinical-nosographic characteristics, an in-depth analysis about systemic-relational theories and historical evolution are provided. In addition, current informations about epidemiological data, recovery, treatment related implications, new neuroscientific theories and risk factors are shown. Given the complexity of these disorders, the lack of resources and the the increasing demands for treatment, the main object is related to the construction of a questionnaire to manage the waiting lists.Objectives Building a waiting list management model for EDs, Study and compare advantages and disadvantages of the source allocation ethical models (utilitarianism, prioritarianism, egalitarianism), Analyze EDs leading experts (doctors, dietitians, psychologists, psychiatrists) and EDs patients positioning with respect to priority treatment factors. Promote constructive dialog between EDs experts from different backgrounds and EDs patients.MethodsIn order to know the various treatment alternatives available, the different levels and reference structures are illustrated. In addition, it is also suggested different reasoning based on the ethical models of egalitarianism, utilitarianism and prioritarianism in order to build a waiting list management model, which is the maximum goal of this work. This model needs to be supported by a series of validated tools such as the clinical interview and self-administered questionnaires to investigate psychopathological aspects and psychiatric symptoms. Going into more details, a questionnaire is proposed to the EDs leading experts, so that they can provide their own priority factors list and related thoughts in order to build “the most ethical” waiting list.ResultsIt is expected that both patients and clinicians tend to give priority to patients with greater psychophysical severity, not exclusively on the basis of physical parameters. Further hypothesis related to clinicians lead us believe that they tend to use utilitarian logics, in compliance with the demonstrated efficacy of early intervention. An evaluation that could lead to a disagreement between experts and patients is related to prioritize patients in the initial phase of the disease, which could be supported by clinicians, but not by patients, probably in connection with their personal experiences. In fact, this favoritism could have a negative impact on the care of the most serious cases who risk to be left to themselves.ConclusionsThis work aims to encourage a constructive dialogue between experts and patients with EDs in order to build a functional intervention model which should be “the most ethical as possible” in order to save the greatest number of lives in respect of mental suffering.Disclosure of InterestNone Declared

Effect of Nursing Intervention Model Guided by BETTER Model on Sexuality Satisfaction and Psychological Status among Chronic Obstructive Pulmonary Disease Women

Effect of Nursing Intervention Model Guided by BETTER Model on Sexuality Satisfaction and Psychological Status among Chronic Obstructive Pulmonary Disease Women

Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model.

Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.

499 Physiological and Metabolomic Effects of a Community-Based Cardiorenal Protective Diet Intervention in African Americans with Chronic Kidney Disease and Hypertension

OBJECTIVES/GOALS: Chronic kidney disease (CKD) impacts 15% of US adults and African American (AA) persons are disproportionately affected with more than 3 times higher risk of kidney failure when compared to Caucasian persons. This study evaluated the physiological and metabolomic effects of increased fruits and vegetables (F&V) on cardio-renal risk factors. METHODS/STUDY POPULATION: This pilot trial used a prospective, 2-group, randomized study design to evaluate a F&V intervention (N=46), where participants received a prescribed amount of fresh, base-producing F&V compared to a wait-list control (WL) condition (N=45). All participants were African American adults (≥18 years), had self-reported hypertension, and had CKD (Stage 1-3) on screening spot-urine microalbumin test. Participants were measured at baseline and 6 weeks post-intervention. Clinical data (i.e., systolic and diastolic blood pressure, lipid panel, hemoglobin A1C, BMI [body mass index], and albumin to creatinine ratio) were collected. Targeted metabolomic quantitative analysis was performed followed by LC-MS/MS and FIA-MS/MS. Linear mixed models evaluated analyte expression and clinical data. RESULTS/ANTICIPATED RESULTS: AA participants (N=91) were aged 58 ± 10.2 years, 66% female, and 54% had incomes ≤$50,000. T-tests compared change scores (baseline to 6-weeks) between groups. The F&V group demonstrated a significant reduction in BMI of -4.7 ± 10.5 kg/m² compared to a 1.9 ± 8.3 kg/m² increase in the WL group, p<.01. Further, the F&V group demonstrated a reduction in total cholesterol of -15.4 ± 58.8 mg/dL compared to a 17.7 ± 68.8 mg/dL increase in the WL group, p<.05. Non-significant reductions in hemoglobin A1c were found in the F&V versus the WL group. Metabolomic analysis indicated significant variation with an increase of suggestive key biomarkers for worse CKD in the WL versus F&V groups at 6-weeks. DISCUSSION/SIGNIFICANCE: Consumption of only 2 cups of F&V via a community-based intervention reduced CVD risk factors in AA adults with CKD and HTN and resulted in molecular/biochemical changes which may improve long-term kidney health. Further investigation may lead to development of cost-effective dietary intervention models to improve CKD outcomes in AA persons.

The Effectiveness of The Family Mentoring Model in Improving the PENSIKU (Knowledge, Attitudes and Behaviour) of Clients and Families in Treating Hypertension

Background: Hypertension is the most common disease experienced by the community and usually appears without complaints so that many clients do not know that they have suffered from hypertension. Until now Hypertension is still a major problem and is the first cause of death in the world. Purpose: This study aims to determine the effectiveness of the family assistance model in improving the PENSIKU (knowledge, attitudes and behavior) of clients and families in treating hypertensive hypertension. Methods: The study design used quasi-experimental Non-Randomized Control Group Pre-Test Post Test Design on 120 hypertensive clients and 120 families. The instrument used in this study was the PENSIKU questionnaire. Equality analysis before intervention and control group models was performed with an independent t-test with α = 0.05. To determine the change in the average value of the intervention and control groups using the dependent t-test. Results: The results showed that the Family Assistance Model was effective in improving the PENSIKU (knowledge, attitudes and behavior) of clients and families in treating hypertensive hypertension. This is shown by the increase in client PENSIKU (knowledge, attitudes and behavior) by 7.1% and family PENSIKU (knowledge, attitudes and behavior) by 5.8%. Conclusions: This model is recommended to be implemented in all community health center areas as an effort to control hypertension.

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.

The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education. This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy. Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies. This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.

Анализ доказательной базы эффективности моделей ранней помощи DIRFloortime и ESDM. Часть 2. Модель ESDM

<p style="text-align: justify;"><strong>Objectives</strong>. Describing empirically proven algorithms of the Early Start Denver Model (ESDM) is a relevant task to compare variants of the model practically presented in the correctional space and the empirically proven variant. The basic empirical studies of the effectiveness of the ESDM model are analyzed.</p> <p style="text-align: justify;"><strong>Methods</strong>. The review considers 9 English-language sources, 5 articles in Russian, and a textbook on the Denver Early Intervention Model, which describe evaluations mainly in the format of randomized and controlled trials of the effectiveness of the ESDM model.</p> <p style="text-align: justify;"><strong>Results. </strong>The results of the analysis of the cited studies indicate a significantly greater effectiveness of the ESDM approach for children with autism spectrum disorders (ASD) compared to standard available care options on such parameters as: receptive and expressive speech, socialization, daily living skills, communication, motor skills, reduction of the main symptoms of autism, and reduction of parental stress.</p> <p style="text-align: justify;"><strong>Conclusions</strong>. The basic evidence-based applications of the ESDM model are described, which include: writing an individualized care plan, intensive sessions with the child for approximately 15 hours per week, regular parent training, independent interaction with children for approximately 2—3 hours per day, and age of onset of care between 18 and 30 months. The conclusion has been made that the Early Start Denver Model (EDSM) is appropriate for working with early age children showing signs of ASD.</p>

"FREED instils a bit of hope in the eating disorder community… that things can change.": an investigation of clinician views on implementation facilitators and challenges from the rapid scaling of the First Episode Rapid Early Intervention for Eating Disorders programme.

First Episode Rapid Early Intervention for Eating Disorders (FREED) is the leading eating disorder (ED) early intervention model for young people. Research has shown that it reduces the duration of untreated illness, improves clinical outcomes, and has cost savings. However, less is known about the experience of implementing FREED. This study aimed to investigate the views and experiences of adopting, implementing, and sustaining FREED from the perspective of clinical staff. Seven focus groups were conducted involving 26 clinicians. Thematic analysis was used, with the Non-Adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability (The NASSS framework) framework being applied to organise subthemes and determine facilitators and barriers. The NASSS framework was also used to rate the complexity of themes as either simple (straightforward, predictable, few components), complicated (multiple interrelating components), or complex (dynamic, unpredictable, not easily divisible into constituent components). There were 16 subthemes identified under seven broader themes representing each domain of the NASSS framework. Key barriers and areas of complexity included factors related to EDs as an illness (e.g., high acuity and prevalence), and organisational complexity (e.g., staffing shortages, lack of managerial/team support). Key facilitators included positive clinician/adopter attitudes, a supportive national network, and the ability for FREED to be flexible/adaptable over time. The FREED model appears to be desirable to clinical staff. Wider team and managerial support was perceived to be particularly important to its successful implementation, as were the national network and supervision. Key areas of complexity include staffing issues and high ED acuity/prevalence. These barriers to implementation need to be managed and investment continued to expand and improve early intervention for EDs further.

Exploring Differentiated Intervention Models of Rural Tourism for Rural Revitalization in China

This article discusses the policy intervention issues faced by rural tourism development in China, which often suffers from a lack of diversity and fails to generate substantial economic and social benefits. To address this situation, the study conducts a comprehensive review of rural tourism literature from both domestic and international sources, and identifies four distinct intervention models, namely, architectural intervention, homestay intervention, red tourism intervention, and religious intervention. Successful cases as illustrations for each model are analyzed and explained. Additionally, the article compares these models across seven dimensions: stakeholders, location, materiality, authenticity, economic effects, social effects, and replicability. This multidimensional analysis reveals the characteristics, impacts, and applicability of each model. The architectural intervention emphasizes attracting tourists through unique architectural projects, heavily relying on the reputation of architects. The homestay intervention demonstrates greater flexibility and wider applicability. This study provides valuable insights into the development of context-specific rural tourism through the principle of place-based development.

Compensatory Strategy Intervention: What Older Patients Want and Why.

Compensatory strategies can improve performance of instrumental activities of daily living in people with cognitive impairment. This study investigated patient interest in compensatory strategy interventions and preference for various intervention formats. Semi-structured qualitative interviews with 38 older adults with cognitive impairment queried motivation to improve strategy use and interest in intervention formats/delivery methods. Two coders used thematic analysis to determine rates of interest in each intervention type and explore patient-reported barriers and facilitators to motivation and intervention models. Most of the samples reported motivation to enhance compensatory strategy use. Degree of motivation was driven by current experiences with strategy use, perceived benefit of potential changes, intrinsic desire to improve life and self, and current perceived need. The vast majority were interested in hour-long, multi-session, instructor-led interventions. Just over half of the sample was interested in a self-directed virtual program, and just under half was interested in involving family/friends. Facilitators and barriers to interest in intervention formats and delivery methods varied based on participants' previous experiences, preferred learning style, content, and time commitment of the intervention, and perceived current need for intervention. One-fifth of the sample expressed no interest in any intervention type, though they expressed openness to assistance in the future as needed. Older adults with cognitive impairment are generally motivated to enhance their compensatory strategy use. Clinicians/researchers designing compensatory strategy interventions should consider instructor-led formats, present individualized benefits of interventions, and demonstrate the benefits of both preventative and remedial intervention to optimize patient engagement.

Contextual and Structural Factors, Project Modelling and Sustainability of Entrepreneurial Development Projects: A Conceptual Framework

Projects emanate from ideas to solve an underlying need. Ideally, a project aims to solve a problem among beneficiaries. Notwithstanding the imperative role of entrepreneurship in socioeconomic prosperity, sustainability of development projects focusing on the empowerment of entrepreneurs is gaining attention on the wheels of research. Of interest are entrepreneurial development projects that fail to attain the desired impacts despite huge capital investments. Ineffective decision-making associated with unrealistic expectations often implicates sustainable delivery of outcomes. Hoverers, foundations for sustainable delivery of entrepreneurship development projects are elusively theorized. Lack of theoretical consent and standardized practice of modelling project intervention relative to attaining sustainable deliverables deprives us of essential knowledge for decision-making. Failure to align project implementation models to the prevailing reality of entrepreneurship is believed to contribute to this dismal. Against the background, this paper presents a theoretical and conceptual framework for the interaction between contextual and structural factors, project modelling and sustainability of entrepreneurial development project interventions. 21 peer-reviewed articles were selected through screening. Meta-analysis was used to review the converging and diverging issues while identifying and synthesizing research gaps that connect with the research problem identified. While project modelling was found to be critical in achieving sustainable impacts, the findings were based on linear perspectives and ignored the prevailing structural and contextual dynamics. Hence, the proposition that structural and contextual factors mediate and moderate the sustainability of entrepreneurial development projects, respectively.

Abstract 3180: Suppression of the CPEB3 ribozyme modulates the progression of glioblastoma

Abstract Glioblastoma multiforme (GBM) is the most aggressive primary malignant brain tumor in adults, with a poor prognosis that highlights a dire clinical need for innovative therapeutic interventions. Despite significant advances in diagnoses and multimodality therapies, the overall prognosis for patients with GBM remains poor, with a median survival time of 15-18 months. Therefore, there is an unmet medical need to develop alternative treatment strategies to improve clinical outcomes. Dysregulation of post-transcriptional control and translational machinery have been implicated in malignant tumor development. Cytoplasmic polyadenylation element binding proteins (CPEB1-CPEB4) are RNA-binding proteins that regulate poly(A) tail elongation of target mRNAs and subsequently contribute to phenotypic changes in cancer cells. Notably, a self-cleaving ribozyme was identified in the CPEB3 gene, but its role in cancer is wholly unexplored. Considering the role of CPEB3 as a tumor suppressor gene and the promotion of cancer progression through the downregulation of CPEB3, our hypothesis is that the CPEB3 ribozyme regulates CPEB3 expression, and its activity contributes to the progression of tumors. Using antisense oligonucleotides (ASOs) as an approach, we demonstrated that inhibition of CPEB3 ribozyme resulted in an increase of CPEB3 mRNA and protein expression. Blocking the CPEB3 ribozyme led to a significant reduction in cell proliferation, migration, and invasion in GBM cell lines. Gene set enrichment analysis (GSEA) revealed the downregulation of epithelial-mesenchymal transition (EMT), angiogenesis, and hypoxia gene sets in GBM cells treated with ASO compared to Ctrl-ASO. We further measured VEGFA mRNA and protein expression and found that ASO-treated GBM cells secreted significantly less VEGF in conditioned media. Inhibition of the CPEB3 ribozyme also mitigated the EMT process in GBM cells. Subsequently, ASO strategies were applied to patient-derived glioma stem cells (GSCs), representing a clinically relevant model for pre-clinical therapeutic intervention. We found that treatment of CPEB3 ribozyme ASO up-regulated CPEB3 mRNA and inhibited cell proliferation in GSCs. Furthermore, the combination of ASO and temozolomide chemotherapy exhibited a more pronounced decrease in GSCs proliferation compared to individual treatment alone. Collectively, this study highlights the significance of the CPEB3 ribozyme in GBM and explores therapeutic approaches focused on targeting CPEB3 in cancer. Citation Format: Claire Chen, Eric Wang, Lily Tong, Mehran Nikan, Daniela A. Bota, Claudia Benavente, Andrej Luptak. Suppression of the CPEB3 ribozyme modulates the progression of glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3180.

Abstract 119: A non-surgical method for developing a pre-clinical orthotopic mouse model for colorectal cancer

Abstract Recapitulating physiologically relevant tumor microenvironment is important yet a significant challenge in modeling colorectal cancer (CRC) for basic and translational studies. Among the different methods, using the cecal-wall injection technique is the most common way to create animal models of colorectal cancer (CRC). However, this approach requires complex surgery, and its unnatural placement creates a significant obstacle for developing treatments. Here, we report a non-surgical procedure for establishing orthotopic CRC mouse models, reflecting the appropriate tumor microenvironment to better model the disease development and facilitate translational studies including drug identification and validation. In this procedure, anesthesia is induced in overnight fasted study immunocompetent or immunodeficient mice while placed on a thermostat-controlled heating blanket. A specialized catheter is inserted and distended into the mouse colon to gently block the colon and ensure the localization for tumor development. Hereafter, the colonic epithelium is treated with proteases and mechanical abrasion to cause mild disruption. Following the local gut inflammation, the targeted colon region is incubated with tumor cells, leading to the adhesion of tumor cells to the colonic epithelium. Based on the animal background and the cell line used, the tumor developed within 3-4 weeks. The stages of tumor development at different time points were successfully confirmed using hematoxylin and eosin stain. Tumor microenvironment data revealed a significant increase in the immune cell infiltration specifically CD4+ T-cells and tumor-associated macrophages in the non-surgical procedure as compared to the cecal-wall injection. Furthermore, a significant increase in the PD-1 expression of the CD8+ T-cells in the cecal-wall injection as compared to the non-surgical procedure, suggests that the precise location of the tumor site may exert a substantial influence on pre-clinical therapeutic outcomes of immune-checkpoint inhibitors, thereby potentially hampering the clinical efficacy of drug treatments. Additional adaptations of this procedure may include: i) tumor development in different mouse strains, ii) local delivery of adeno-Cre in transgenic mice for CRC, and iii) delivering tumor organoids and patient-derived xenografts in immuno-deficient mice. Overall, our non-surgical procedure overcomes the technical difficulties of surgery and offers several advantages like ease of handling, cost-effectiveness, pain-free with nearly no procedure-associated mortality and adaptability to several strains. In conclusion, this procedure provides novel and promising alternative to conventional surgical orthotopic CRC mouse models for therapeutic interventions. Citation Format: Naresh Singh, Samantha Sharma, Kevin Van Der Jeught, Zhuolong Zhou, Xinna Zhang, Xiongbin Lu. A non-surgical method for developing a pre-clinical orthotopic mouse model for colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 119.